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FOR OFFICE USE: } ---- ----------- -------------------------------------- Permit No. --- APPLICATION FOR SANITATION PERMIT y [Complete in Duplicate} / Date Issued _ ---------- ------------ ------ ------------ _ //_ .ZS'- --------- -- This Permit Expires 1 Year From Date Issued k r 3—t Atruct pplication is hereby made to the San Joaquin Local Health District for a permit to consand install the wor herein described. This application is made in compliance with County Ordinance No. 549. o - i -.P- �. k JOB ADDRESS AN OCATION ti - a 71 --- � --- !--- L -------------------------- --------------- Owner's Name ------ Phone "��— q ------------------ ----- -- - ---- ------ -------------- -- -------------- Address--------------------- -- f p t��. --V------�-----�4 Contractor's Name-- ----` �_.t.- ---- -------- Phonl4 - a __ Installation will serve: Residence ❑ Apartment House Commercial ❑ Tr�aileer o r l ❑ Other ❑ Number of living units: ---_-_- Number of bedrooms -------- Number of b the _/__._ Lot size ___ ______________ ----- --------- Water Supply: Public system ❑ Community system ❑ Private Depth to ater Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: C7 (No septic tank or cesspool permitted i blit sewer is available within 200 feet.) Dist ce frarp foun atibYs____'-- -------.Material---..- ------------ - r T Se tic Ta Distance from nearest w�1 _ �Y _ /dpSiz ;7I� lFj quid depth Cai'acitYNo. of compartments___ _ __________----i � Distance to nearest lot Disposal Field.: Distance from neare t well_6..O__. _Distance from founciation___�i -------. Number of lines-------_ Length of each line-_ f �------------ -- ---_--- �`�--- ------------Width of trench of filter material.e _% --Depth of filter material----.-�__�----_--.Total length_.-.__.. ---------- ----- d Seepage Pit: Distance to nearest well--------------------._Distance from foundation------------------- Distance to nearest lot line----------------- � ❑ Number of pits-------------- -------Lining material-------------- --------Size: Diameter------------------ ---.Depth- ----------- ------------------ d t 1 i Cesspool: Distance from nearest well___-------------Distance from foundation-------------.------Lining material------------__-.--------------- al-- r• ❑ Size: Diameter----- --------------- --------------- Depth------------------ --------- Liquid Capacity ---- p' --.-Distance from nearest building -------------------- Privy: Distance from nearest well--------------------------------------- --- g-____.____..---.--"--- II ❑ Distance to nearest lot line------------------ ------------------------------------------------------------------------------ Remodeling and/or repairing (describe):-------------------- ------------- ---------------------------t--------------------- ----- ------------ ------- - ---------- --- --------------=---------------------------------------------------------------------------------------------------------------------------------------------------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County iordinances, ate laws, and rules and regulatio s of the San Joaquin Local 1jealth District. \ � f . - �C�--.------------�dAaL_Contractor) [Signe 1 - !� �----- --- --- �_ ------- ------ -- T the _ (Piot plan, showing size of lot, location of system in relation to wells, ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY.. --------------- ---------------------------------------------- DATE-----------------#_'S... -- . ....................... REVIEWEDBY------------------------- - ------------ -............. --------------------------------- ---- DATE----------------..---------------- BUILDINGPERMIT ISSUED-------------------- ---------------------- ------------------------------------------------------- DATE------------------------------------- t Alterations and/or recommendations------------------------- • - •- ----- - ----------------------------------------------------------------------------- -- ---•--------' ------------------- --- kI -------------- --------------------------------- ------------ --------------------------------- ------------------ ----------------- . f a r, �A ---------------- Date._ r^_r G's ------------- -- f FINAL INSPECTION BY:. -�,�f � - SAN JOAQUIN LOCAL HEALTH DISTRICT 1501 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.n.co.